Wang Haochen, De Steur Hans, Chen Gong, Zhang Xiaotian, Pei Lijun, Gellynck Xavier, Zheng Xiaoying
Institute of Population Research/WHO Collaborating Center on Reproductive Health and Population Science, Peking University, Beijing 100871, China.
Department of Agricultural Economics, Faculty of Bio-Science engineering, Ghent University. Ghent 9000, Belgium.
Nutrients. 2016 Mar 9;8(3):152. doi: 10.3390/nu8030152.
Despite efforts to tackle folate deficiency and Neural Tube Defects (NTDs) through folic acid fortification, its implementation is still lacking where it is needed most, highlighting the need for studies that evaluate the effectiveness of folic acid fortified wheat flour in a poor, rural, high-risk, NTD region of China. One of the most affected regions, Shanxi Province, was selected as a case study. A community intervention was carried out in which 16,648 women of child-bearing age received fortified flour (eight villages) and a control group received ordinary flour (three villages). NTD birth prevalence and biological indicators were measured two years after program initiation at endline only. The effect on the NTD burden was calculated using the disability-adjusted life years (DALYs) method. In the intervention group, serum folate level was higher than in the control group. NTDs in the intervention group were 68.2% lower than in the control group (OR = 0.313, 95% CI = 0.207-0473, p < 0.001). In terms of DALYs, burden in intervention group was approximately 58.5% lower than in the control group. Flour fortification was associated with lower birth prevalence and burden of NTDs in economically developing regions with a high risk of NTDs. The positive findings confirm the potential of fortification when selecting an appropriate food vehicle and target region. As such, this study provides support for decision makers aiming for the implementation of (mandatory) folic acid fortification in China.
尽管通过叶酸强化来解决叶酸缺乏和神经管缺陷（NTDs）问题已做出诸多努力，但在最需要的地方其实施情况仍然欠佳，这凸显了开展相关研究以评估叶酸强化小麦粉在中国贫困、农村、高风险NTD地区有效性的必要性。受影响最严重的地区之一山西省被选作案例研究。开展了一项社区干预，其中16648名育龄妇女接受了强化面粉（八个村庄），一个对照组接受普通面粉（三个村庄）。仅在项目启动两年后的终期测量了NTD出生患病率和生物学指标。使用伤残调整生命年（DALYs）方法计算对NTD负担的影响。干预组的血清叶酸水平高于对照组。干预组的NTDs比对照组低68.2%（OR = 0.313，95% CI = 0.207 - 0.473，p < 0.001）。就DALYs而言，干预组的负担比对照组低约58.5%。在NTD高风险的经济欠发达地区，面粉强化与较低的NTD出生患病率和负担相关。这些积极结果证实了在选择合适的食物载体和目标地区时强化的潜力。因此，本研究为旨在在中国实施（强制性）叶酸强化的决策者提供了支持。
